JMIR Publications

ABSTRACT

Background:

Traditional assessments of clinical competence using multiple-choice questions (MCQs) have limitations in the evaluation of real-world diagnostic abilities. As such, recognizing non-verbal cues, like tachypnea, is crucial for accurate diagnosis and effective patient care.

Objective:

This study evaluated how detecting such cues impacts resident physicians’ clinical competence using a clinical simulation video (CSV) integrated into the General Medicine In-Training Examination (GM-ITE).

Methods:

This multicenter cross-sectional study enrolled first- and second-year resident physicians who participated in GM-ITE 2022. Participants watched a five-minute CSV depicting a patient with acute pulmonary thromboembolism and subsequently answered diagnostic questions. Propensity score matching (PSM) was used to create balanced groups of resident physicians who detected tachypnea (detection group) and those who did not (non-detection group). After matching, we compared GM-ITE scores and the proportion of correct CSV-IE answers between the two groups. Subgroup analyses assessed result consistency.

Results:

In total, 5,105 resident physicians were included, from which 959 pairs were identified after PSM. Covariates were well balanced between the detection and non-detection groups (standardized mean difference < 0.1 for all variables). Post-matching, the detection group achieved significantly higher GM-ITE scores (mean=47.6, SD=8.4) than the non-detection group (mean=45.7, SD=8.1; mean difference=1.9, 95% CI: 1.1–2.6; p=0.041). The proportion of correct CSV-IE answers was also significantly higher in the detection group (39.2% vs. 3.0%; difference=36.2%, 95% CI: 32.8–39.4). Subgroup analyses confirmed consistent results across sex, postgraduate years, and age groups.

Conclusions:

Overall, this study showed that detecting non-verbal cues like tachypnea significantly affects clinical competence, as evidenced by higher GM-ITE scores among resident physicians. Integrating video-based simulations into traditional MCQ examinations enhances the assessment of diagnostic skills by providing a more comprehensive evaluation of clinical abilities. Thus, recognizing non-verbal cues is crucial for clinical competence. Video-based simulations offer a valuable addition to traditional knowledge assessments by improving clinicians’ diagnostic skills and preparedness.